Oncologist flags cancer care gaps: Late treatment, high costs, poor access hinder fight
Telegraph | 12 July 2025
A yawning mismatch between demand and resources, delaying diagnosis, and high treatment costs are the two main challenges in cancer care in India, said a visiting expert from Singapore on Friday.
Ang Peng Tiam, medical director and senior consultant at Parkway Cancer Centre in Singapore, said faster, accurate diagnosis and a multidisciplinary approach can improve patient outcomes — including life expectancy, quality of life and psychological well-being.
Tiam, a Stanford-trained medical oncologist, also stressed that health insurance is key to making cancer treatment accessible.
Quick diagnosis key
“At Parkway Cancer Centre, we usually complete a detailed diagnosis within 48 hours. The biopsy report is ready by then, and patients are clearly informed about the stage of the disease, treatment protocol, and other details,” said Tiam.
The Singapore centre treats many patients from India, Bangladesh, Malaysia and Indonesia.
“A common problem among Indian patients is that they undergo treatment for long periods without a clear understanding of their condition,” said Tiam. “It seems there is a lack of proper information.”
“If diagnosis of the stage and a clear treatment plan are delayed, it causes significant stress for patients and families,” he said. “I see many Indian patients arriving at an advanced stage due to delays in diagnosis.”
Tiam observed that India’s high demand and limited resources often lead to late diagnoses.
In India, biopsy reports can take a week or more. Patients may wait weeks or even months to begin radiation therapy.
Tanuja Shet, head of pathology at Tata Memorial Hospital in Mumbai, said biopsy time depends on specimen size. She was in Calcutta for an oncopathology conference at RN Tagore International Institute of Cardiac Sciences.
“We do tissue processing. It goes through a machine, sliced thin and placed on slides. Bigger specimens take more time,” explained Shet.
“A small specimen can be checked in 6-8 hours. But when collected by small labs and sent to bigger labs, even small samples can take days. For large specimens, it typically takes at least three days.”
Low insurance cover
Tiam also flagged affordability as a major issue in India, with most patients lacking insurance.
“I have seen many Indian patients return with cancer recurrence after a few years, which ideally shouldn’t happen,” he said. “Two reasons for this could be late-stage diagnosis and the inability to get the best possible treatment due to cost.”
Medical insurance plays a crucial role in cancer treatment because of the high costs involved. “Healthcare financing plays a major role,” said Tiam.
Multi-disciplinary model
The oncologist stressed the importance of a multi-disciplinary approach in cancer treatment.
At Parkway Cancer Centre in Singapore, medical, surgical, and radiation oncologists work alongside oncology-trained nurses, psychologists and dieticians.
“A patient spends only a short time with the doctor. But once they enter the treatment area, they may spend hours there. Nurses, specially trained in cancer care, hold detailed conversations with patients, helping them understand their condition and treatment,” Tiam said.
Dieticians also play a key role.
“Often, patients have no appetite or struggle with swallowing. The dietician speaks to them and advises them on foods they can tolerate and feel comfortable with,” he said.
Tiam noted that many Asian patients are reluctant to open up in group settings. “Group counselling isn’t always effective. We have found that individual sessions with psychologists help more. So, we give a lot of importance to one-on-one counselling.”
Oncopathology is another vital department.
“It is the cornerstone of cancer treatment. Everything depends on fast and accurate diagnosis,” said Tiam.
“Oncopathology is of paramount importance because it covers three essential aspects — diagnosis, prognostication and prediction of treatment outcome,” explained Devmalya Banerjee, consultant and lead oncopathologist at NH Cancer Centre and RN Tagore International Institute of Cardiac Sciences.
Access, communication
At the Singapore centre, doctors share their handphone numbers with patients.
“They call or message doctors about problems while undergoing treatment. I get queries from patients with issues like loss of appetite. We respond to every query,” said Tiam.
In India, patients often complain about a lack of access to doctors during treatment.
“Again, high demand and inadequate resources are likely the cause. It’s difficult for one doctor to stay in constant touch with many patients,” he said.